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A pilot study was conducted in the framework of the Save the Mountains initiative, an education and sustainability project, promoted by Italian Alpine Club of Bergamo, Bergamo section of the National Alpine Association, Province of Bergamo, Observatory for the Bergamasque Mountains and Alpine and Speleological Rescue. As a part of this study, an anonymous online questionnaire was designed and prepared, collecting lifestyle information (eating habits, alcohol, tobacco, sleep, exercise) of the mountaineers in order to recommend specific measures useful for staying in mountain areas and for preventing individual risk factors related to lifestyle and Acute Mountain Sickness (AMS): http://altamontagna.isti.cnr.it:8080/Stiledivita/. The study will continue the collection of questionnaire responses until at least the end of Summer 2021; at the time of writing (February 2021), 804 questionnaire responses were already collected and analyzed. The initial sample refers to the people who attended mountain huts in the Orobie Alps; then the online questionnaire form was publicly extended to other regions. About 99% of the interviewed people are Italian; the rest are Swiss, Polish, British and French people. Mean age is 48 years(+/-15), 62% males and 38% females. Only 8.8% of them answered they suffered from altitude sickness, but self-reported Lake Louise Score (LLS) classified the 21.3% of people with Acute Mountain Sickness (AMS), light AMS 15,4% and severe AMS 5,8% (To assess AMS the original LLS questionnaire was used: AMS is classified as severe when a headache is present and the LLS is greater than 5, it is instead light when there is a headache and the LLS is between 3 and 5, else is normal). The Mediterranean Diet's adherence, collected as the frequency of food items consumption, was assessed by the MEDI-LITE score, a validated questionnaire, ranging from 0 to 13. In this sample, a median score of 8 was found, while the 25th percentile corresponds to a score lower than 6 and the 75th percentile to a score greater than 9. The 14% of the sample resulted in being not adherent to the Mediterranean diet, the 51% was in the mean, the 35% was adherent. This study confirms that the predisposing factor most associated with the AMS is "having had the same episode in the past" (OR 2.50, CI 1.88/3.13), having sleep disturbs (OR 1.29, CI 1.03 /1.55), age (OR -0.03, CI -0.35/-0.02). Moreover, it underlines that lifestyle is important with respect to risk to develop the AMS: actually, despite the structural limitations of surveys, this study pointed out that lifestyle contributes to mitigating the risk of developing the AMS (Mediterranean diet score OR - 0.34, CI -0.64 -> - 0.55). Gender, smoke and high physical activity are instead not significant. Future studies should investigate more deeply how lifestyle can change the impact on high altitude diseases.

This study investigates the possible dampening action of the biceps brachii on the execution of a boxing cross punch directed to a solid elastic target in a population of skilled and unskilled boxeurs. This work uses a surface electromyography sensor paired with an accelerometer inside the impact target to analyze the action of the biceps brachii during the cross punch performance.

La variazione dei frequentatori della montagna degli ultimi anni sta significativamente cambiando le problematiche del territorio montano: se da un lato aumenta il numero delle presenze temporanee (turisti, lavoratori, etc...), dall'altro diminuisce quello degli abitanti. Il primo, tra le varie, sta elevando il Male Acuto di alta Montagna (MAM) a problema di salute pubblica non trascurabile; il secondo porta ad una minore gestione del territorio generando problemi diretti ed indiretti, tra questi, favorito altresì dal riscaldamento globale, anche la proliferazione delle zecche. Questa ricerca ha esaminato in particolare I fattori di rischio individuale relativo allo stile di vita e al MAM.

Una applicazione sul Male Acuto di Montagna per il frequentatore delle montagne

Introduction: High levels of reactive oxygen species (ROS) and impaired antioxidant defense systems lead to oxidative stress (OxS) and tissue injury in different intestinal and extra intestinal conditions, including celiac disease (CD). The aim of the present study was to investigate the role and potential use of ROS and other biomarkers of OxS in the clinical management of CD. Methods: We collected duodenal specimens and blood samples from naïve patients (N-CD), patients on a gluten free diet (GFD) including responders (CD-GFD) and non-responders (NRCD). We measured plasmatic ROS production (electron paramagnetic resonance, EPR), lipid peroxidation (thiobarbituric acid-reactive substances, TBARS), protein oxidation (protein carbonyl, PC), total antioxidant capacity (TAC), nitric oxides and glutathione (GSH) in erythrocytes. Results: Fifty-four patients affected by CD were enrolled (17 N-CD, 18 CD-GFD and 19 NRCD; 44 F; age 44 ± 13 years). A significant increase of plasmatic OxS biomarkers (ROS, peroxidated lipids, oxidized proteins, and nitrate concentrations) and decrease of antioxidant species (TAC and GSH levels) were found in NRCD and N-CD compared to CD-GFD. Comparably, a significant direct relationship between the severity of duodenal atrophy, ROS production rates and TBARS was found; conversely, TAC and GSH presented an inverse correlation. Discussion: OxS is involved in CD tissue damage and correlates with the degree of duodenal atrophy. These findings suggest the possible role of OxS biomarkers as indicators of CD activity during the clinical follow-up.

INTRODUCTION: Hyperbaric oxygen (HBO?) therapy and use of enriched air can result in oxidative injury affecting the brain, lungs and eyes. HBO? exposure during diving can lead to a decrease in respiratory parameters. However, the possible effects of acute exposure to oxygen-enriched diving on subsequent spirometric performance and oxidative state in humans have not been recently described recently. We aim to investigate possible effects of acute (i) hyperbaric and (ii) hyperbaric hyperoxic exposure using scuba or closed-circuit rebreather (CCR) on subsequent spirometry and to assess the role of oxidative state after hyperoxic diving. METHODS: Spirometry and urine samples were obtained from six well-trained divers (males, mean ± SD, age: 43.33 ± 9.16 years; weight: 79.00 ± 4.90 kg; height: 1.77 ± 0.07 meters) before (CTRL) and after a dive breathing air, and after a dive using CCR (PO? 1.4). In the crossover design (two dives separated by six hours) each subject performed a 20-minute session of light underwater exercise at a depth of 15 meters in warm water (31-32°C). We measured urinary 8-isoprostane and 8-OH-2-deoxyguanosine evaluating lipid and DNA oxidative damages. RESULTS: Different breathing conditions (air vs. CCR) did not significantly affect spirometry. A significant increase of 8-OH-dG (1.85 ± 0.66 vs. 4.35 ± 2.12; P ? 0.05) and 8-isoprostane (1.35 ± 0.20 vs. 2.59 ± 0.61; P ? 0.05) levels after CCR dive with respect to the CTRL was observed. Subjects did not have any ill effects during diving. CONCLUSIONS: Subjects using CCR showed elevated oxidative stress, but this did not correlate with a reduction in pulmonary function.

Wearable sensors currently represent a non-invasive way of monitoring health-related parameters, quite useful for both self-assessment and naturalistic studies. The autonomic imbalance experienced by athletes engaged in strenuous physical exercises could be also seen through this minimally obtrusive approach, possibly opening the field to a variety of novel investigations. Here, 41 athletes, taking part to two of the most strenuous ultra-trail competitions in Europe were assessed in terms of autonomic evaluation before, during and after the race, through a minimally invasive ECG system based on a fitness-like chest strap. Results showed an increased sympathetic activity both before and after the race, whereas vagal tone appeared increased during the race. Having proven the good feasibility of the proposed approach in such field, further investigations are needed to clarify the scientific basis explaining such modifications.

Introduction: Given the wide proliferation of ultra-long endurance races, it is important to understand the physiological response of the athletes to improve their safety. We evaluated the cognitive and neurosensory effects on ultra-endurance athletes during the Transpyrénéa (866 Km, 65,000 m positive slope), held on the French Pyrenees. Materials and Methods: 40 athletes were enrolled (age 43.8±8.8 years; 36 males). Olfactory and cognitive tests were performed before the race (T0, n=40), at 166 kms (T1, n=28), at 418 kms (T2, n=20) and after the race (T3, 866 kms, n=13). The effect of dehydration and sleep deprivation on cognitive features were also studied. Results: Olfactory function decreased during the race (T0: 24.9±4.3 vs T3: 22.8±3.5, z=-2.678, p=0.007), language fluency increased (T0: 10.8±2.9; T1: 11.4±2.7; T2: 12.9±2.8; T3: 12.9±3.0; ?2=11.132, p=0.011 for combined samples), whereas the Trail Making Test did not show any changes between pre- and post-race (T0 vs T3 p=0.697 for TMT-A, p=0.977 for TMT-B). The mean aggregate sleeping time was 9.3±5.4 h at T1, 22.4±10.0 h at T2, 29.5±20.5 h at T3, with a correlation with olfactory function(r=0.644, p=0.018), while Total Body Water (TBW) was not correlated with olfactory or cognitive scores. Conclusion: Physical activity and sleep restriction in ultra-endurance could transiently affect olfactory function, while verbal fluency improved, demonstrating a dissimilar mechanism of activation/deactivation in different cortical areas. Body water loss was uncorrelated to cognition. Further studies should clarify whether cognitive and sensory deficits occur even in absence of sleep restriction.

BACKGROUND: Strenuous and chronic exercise training can have detrimental effects on cardiac morphology and function. Our aim was to evaluate the cardiac adaptation between 2 different specialties' endurance athletes: marathon runners (M) and ultra-trailers (UT). METHODS: 47 M (age 45±7, men 32; training: 18 (9-53) years*days/week), 41 UT (age 42±9, men 38, training: 30 (15-66) years*days/week) were submitted in rest condition to conventional 2D echocardiography and Speckle-Tracking echo (STE) (Beyond Diogenes 2.0, AMID) during agonistic season and compared with 15 age matched sedentary individuals (S) (age 43±6, men 10). RESULTS: Left ventricle (LV) global longitudinal strain (GLS) and global radial strain (GRS) were increased in M and UT compared to S (see table) without differences in LV anatomy and function. Right ventricle (RV) end-diastolic area (p=0.026), fractional area changing (p=0.008) and RV GLS were increased in UT compared to M. Moreover UT showed larger right atrium (RA) volume compared to M (p=0.03) and S (p=0.003). RA GLS was reduced in UT compared to M while the RA Global Circumferential Strain was significantly increased in UT. After adjusted for age, sex and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M; while when compared to S subjects, UT showed increased RA volume (OR 1.048; CI 1.002-1.096) and RV GLS (OR 0.667; CI 0.490-0.907). CONCLUSION: UT showed higher RV and RA morphological and functional remodeling in comparison with M. 2D-STE is a useful tool to investigate the deformation dynamic in different sport specialties. Further studies will be necessary to clarify the long-term consequences for cardiac health due to myocardial perturbations.

Despite the wide diffusion of subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease, systematic practical recommendations for intraoperative electrophysiological monitoring are still lacking. In this paper, a shared protocol for intraoperative electrophysiological monitoring arising from the meetings of a panel of neurophysiologists of the DBS Study Group of the Italian Neurological Society is proposed. Intraoperative monitoring is composed by microrecordings and functional stimulation. In microrecordings, it is recommended to use at least 2-3 electrodes, descending with steps of 0.5-1 mm and waiting at least 60 s before changing the position. Functional stimulation is used to assess the clinical efficacy and the side effects induced by STN-DBS at different positions. Based on the therapeutic window, an algorithm to find the optimal target is proposed. The procedures for intraoperative monitoring for STN-DBS proposed here are safe, relatively cheap, take approximately 30-40 min per side and could offer valuable additional information to the surgeon.

Deep brain stimulation (DBS) of the ventralis oralis (VO) complex of the thalamus improves tics in patients with Tourette syndrome (TS). To neurophysiologically describe the VO complex we recorded, in seven patients with TS undergoing DBS electrode implantation, single-unit activity during surgery and local field potentials (LFPs) a few days after surgery. Single unit recordings showed that the VO complex is characterized by a localized pattern of bursting neuronal activity. LFP spectra demonstrated that VO of TS patients has a prominent oscillatory activity at low frequencies (2-7 Hz) and in the alpha-band (8-13 Hz), and a virtually absent beta activity. In each patient, the main LFP frequency significantly correlated with single-unit interburst frequency. In conclusion, we observed an oscillatory bursting activity in the VO as target region in patients with severe TS undergoing DBS surgery.

Tourette syndrome (TS) is a chronic neuropsychiatric disorder, characterized by the presence of multiple motor and phonic tics, with onset in early childhood.1 Because weak electrical currents applied to the brain induce persistent excitability changes in humans, and because neurophysiological studies document abnormal motor cortex excitability in patients with TS, we investigated whether transcranial direct current stimulation (tDCS) might reduce the frequency of these patients' tics. Here we report the results of the application of tDCS for five consecutive days in two patients with TS.